The Management of Severe Asthma

Welcome to the World Allergy Forum Symposium and Introduction to "The Management of Severe Asthma"

G. Walter Canonica

Dear Colleagues and Friends,

It is my pleasure to welcome you to the American College of Allergy, Asthma and Immunology Annual Scientific Meeting, and to the 27th World Allergy Forum symposium, "The Management of Severe Asthma". The World Allergy Forum is the longest-running educational program of World Allergy Organization (WAO), and we are proud to bring you an excellent international faculty for today's symposium. WAO sincerely recognizes the unrestricted educational grant, provided by Novartis and Genentech, which supports the World Allergy Forum program.

WAO is an alliance of allergy and clinical immunology societies, and currently represents almost 80 Allergy and Clinical Immunology Societies around the world. Partnership with our member organizations is essential for the success of WAO and the worldwide development of Allergy as a specialty. I would like to warmly thank Dr. Mike Zitt and ACAAI for hosting today's World Allergy Forum presentation.

In 2005, as an addition to World Allergy Forum and the well-established Global Resources in Allergy - GLORIATM program, WAO launched the Seminars and Conferences Program. This new program offers member societies the opportunity to apply for WAO Lectureships at member society meetings, to provide an international speaker to lecture on a topic of the society's choice. WAO is very proud of the outstanding educational programs it offers, and in collaboration with the ACAAI, WAO is now working to bring GLORIATM to regional and local allergy meetings in the United States. This project is currently under development, but we urge you to regularly visit the WAO Web site: www.worldallergy.org for updates about the program.

To automatically receive updates on WAO activities and membership benefits, register for WAO News and Notes, our monthly e-letter. Each e-letter offers a review of the latest allergy papers published in the major journals, news from our member societies, information about WAO happenings, and other items, such as new allergy book reviews and educational synopses on all aspects of allergic disease. To subscribe to our e-letter, please visit www.worldallergy.org.

Thank you for attending this World Allergy Forum symposium today and for your valuable contribution to the specialty of allergy.

In this era of economic rationalism, physicians like everyone else must give good account for the money spent on medications and health care delivery and they need to be able to justify expenditure in terms of cost benefit analyses. In order to do this, physicians have had to learn the language of the accountant and use the tools of the economist.

The World Allergy Organisation is very pleased to present its World Allergy Forum at the 2005 American College of Allergy, Asthma and Immunology meeting in Anaheim. In the symposium, three experts will address the topic "Unmet Needs and Economic Burden of Asthma".

Dr Michael Blaiss will discuss the ways in which health care costs are considered and will discuss direct, indirect and intangible costs as they apply to the management of patients with severe asthma so that we may then consider the economic burden of this disease upon the individual and the community.

It will become clear that severe asthma consumes a disproportionate share of health care resources with half the costs occurring in the most severe 10% of the asthmatic population. According to Cisternas et al (J Allergy Clin Immunol 2003;111:1212-8), pharmaceuticals are the largest contributor to total health care costs in asthma, particularly in mild asthma. It is interesting to note that as disease severity increases from mild to severe, the percentages of total costs attributed to medication declines from 47% to 19%. Effective controller medications have been demonstrated to reduce other high-cost components of health care including hospitalizations. The expenses of the treatment failures are magnified in both increased need for hospitalization and indirect costs.

Dr Michael Kaliner will present the findings of the TENOR study and discuss insights it has given us into the impact of severe and difficult-to treat asthma on patients and on the health care system. Despite being on multiple standard-of-care medications, including high dose inhaled CCS, LABA and leukotriene antagonists, the TENOR cohort reports surprisingly high rates of healthcare utilization, most notably patients requiring hospitalization or ER care, as well as a high number of patients with a history of intubation.

The reasons why such patients have problems such as concomitant disease and lack of compliance are explored. The TENOR study highlights the need for every physician caring for patients with severe asthma to optimize management by focusing on issues such as patient education, minimizing the impact of allergic triggers and managing concomitant disease such as GERD, sinusitis and sleep apnoea. In this particular population we must continue to strive for new treatments with the ability to enhance control and decrease asthma exacerbations. In the context of severe asthma, expensive new medications such as omalizumab are potentially cost effective options needing careful consideration. Prof. Carlos Baena-Cagnani will address the treatment of severe asthma and present results of the Investigation of Omalizumab in Severe Asthma Treatment (INNOVATE) study.